Coding Preventive Care
Coding Preventive Care
The recommendations in this publication do not indicate an exclusive course of treatment or serve as a
standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in
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permission from the publisher.
Current Procedural Terminology (CPT ®) 5-digit codes, nomenclature, and other data are copyright 2017
American Medical Association (AMA). All rights reserved. No fee schedules, basic units, relative values, or
related listings are included in CPT. The AMA assumes no liability for the data contained herein.
1
The Bright Futures/American Academy of Pediatrics (AAP)
Recommendations for Preventive Pediatric Health Care, also
known as the “Periodicity Schedule,” is a schedule of screenings
and assessments recommended at each well-child visit from
infancy through adolescence. The following services and codes
coincide with this schedule. For more details on the Periodicity
Schedule see www.aap.org/periodicityschedule.
2
preventive medicine service code. Modifier 25 should be
appended to the office or other outpatient service code to
indicate that a significant, separately identifiable E/M service
was provided by the same physician on the same day as the
preventive medicine service.
❖❖ An insignificant or trivial illness, abnormality, or problem
encountered in the process of performing the preventive
medicine service that does not require additional work and
performance of the key components of a problem-oriented
E/M service should not be reported.
❖❖ The comprehensive nature of the preventive medicine
service codes reflects an age- and gender-appropriate history
and physical examination and is not synonymous with the
comprehensive examination required for some other E/M
codes (eg, 99204, 99205, 99215).
❖❖ Immunizations and ancillary studies involving laboratory,
radiology, or other procedures, or screening tests (eg, vision,
developmental, and hearing screening) identified with
a specific CPT ® code, are reported separately from the
preventive medicine service code.
3
and other qualified health care professionals who may
report E/M services and reported by a specific CPT ® code(s)
from a physician/other qualified health care professional, or
another physician/other qualified health care professional of
the exact same specialty and subspecialty who belongs to
the same group practice, within the past 3 years.
4
CPT ® Codes ICD-10-CM Codes
99391 Infant (younger than 1 year) Z00.110 Health supervision for newborn under
8 days old or
Z00.111 Health supervision for newborn 8 to
28 days old or
Z00.121 Routine child health exam with
abnormal findings
or
Z00.129 Routine child health exam without
abnormal findings
5
❖❖ Codes are time-based, where the appropriate code is
selected according to the approximate time spent providing
the service. Codes may be reported when the midpoint
for that time has passed. For example, once 8 minutes are
documented, one may report 99401.
❖❖ Extent of counseling or risk factor reduction intervention
must be documented in the patient chart to qualify the
service based on time.
❖❖ Counseling or interventions are used for persons without a
specific illness for which the counseling might otherwise be
used as part of treatment.
❖❖ Cannot be reported with patients who have symptoms or
established illness.
❖❖ For counseling individual patients with symptoms or
established illness, report an office or other outpatient
service code (99201–99215) instead.
❖❖ For counseling groups of patients with symptoms or
established illness, report 99078 (physician educational
services rendered to patients in a group setting) instead.
6
CPT ® Codes
7
counseling codes (99401–99404) if the patient is not
currently experiencing adverse effects (eg, illness), or include
under the problem-related E/M service (99201–99215).
❖❖ Codes (99406-99409) may be reported in addition to the
preventive medicine service codes.
99406 Smoking and tobacco use cessation counseling visit;
intermediate, greater than 3 minutes up to 10 minutes
99407 intensive, greater than 10 minutes
99408 Alcohol or substance (other than tobacco) abuse struc-
tured screening (eg, Alcohol Use Disorder Identification
Test [AUDIT], Drug Abuse Screening Test [DAST]) and
brief intervention (SBI) services; 15 to 30 minutes
99409 greater than 30 minutes
8
Z71.6 Tobacco abuse counseling
Z87.891 Personal history of nicotine dependence
Z91.89 Other specified personal risk factors, presenting as
hazards to health not elsewhere classified
Z00.121
Z00.129
Z29.3 Encounter for prophylactic fluoride administration
• Z91.841 Risk for dental caries, low
• Z91.842 Risk for dental caries, moderate
• Z91.843 Risk for dental caries, high
• Z91.849 Unspecified risk for dental caries
PELVIC EXAMINATION
❖❖ Preventive medicine service codes (99381–99385 and
99391–99395) include a pelvic examination as part of the
age- and gender-appropriate examination.
9
❖❖ If the patient is having a problem, the physician can report
an office or other outpatient E/M service code (99212–
99215) for the visit and attach modifier 25, which identifies
that the problem-oriented pelvic visit is a separately
identifiable E/M service by the same physician on the same
date of service.
❖❖ Link the appropriate ICD-10-CM code for the well-child
or well-adult exam with abnormal findings (Z00.121 or
Z00.01) to the preventive medicine service code, but link
a different diagnosis code (eg, N89.8 [vaginal discharge],
N94.4 [primary dysmenorrhea]) to the office or other
outpatient E/M service code (eg, 99212).
❖❖ Anticipatory or periodic contraceptive management is not
a “problem” and is therefore included in the preventive
medicine service code; however, if contraception creates a
problem (eg, breakthrough bleeding, vomiting), the service
can be reported separately with an office or other outpatient
service code.
ICD-10-CM Codes
10
Z30.015 Encounter for initial prescription of vaginal ring
hormonal contraceptive
Z30.016 Encounter for initial prescription of transdermal
patch hormonal contraceptive device
Z30.017 Encounter for initial prescription of implantable
subdermal contraceptive
Z30.018 Encounter for initial prescription of other
contraceptives
Z30.02 Counseling and instruction in natural family planning
to avoid pregnancy
Z30.09 General counseling and advice on contraception
Z30.40 Surveillance of contraceptives, unspecified
Z30.41 Surveillance of contraceptive pills
Z30.42 Surveillance of injectable contraceptive
Z30.430 Insertion of IUD
Z30.431 Routine checking of IUD
Z30.432 Removal of IUD
Z30.433 Removal and reinsertion of IUD
Z30.44 Encounter for surveillance of vaginal ring
hormonal contraceptive device
Z30.45 Encounter for surveillance of transdermal patch
hormonal contraceptive device
Z30.46 Encounter for surveillance of implantable
subdermal contraceptive
Z30.49 Surveillance of other contraceptives
11
HEALTH RISK ASSESSMENTS
CPT ® Codes
13
❖❖ Other identifiable services unrelated to the screening test
provided at the same time are reported separately (eg,
preventive medicine services).
❖❖ Failed vision screenings will most likely result in a follow-
up office visit (eg, 99212–99215). Report the follow-
up screening with Z01.00 if normal results or Z01.01 if
abnormal results. If abnormal, link to the diagnosis code
for the reason for the failure (eg, H52.1- [myopia]); when
a specific disorder cannot be identified, report R94.118
(abnormal results of other function studies of eye).
HEARING SCREENING
CPT ® Codes ICD-10-CM Codes
92551 Screening test, pure tone, air only Z00.121 Routine child health exam with
92552 Pure tone audiometry (threshold), abnormal findings
air only Z00.129 Routine child health exam without
92567 Tympanometry (impedance testing) abnormal findings
14
❖❖ Failed hearing screenings will most likely result in a follow-up
office visit (eg, 99212–99215). Code Z01.110 (encounter
for hearing exam following failed hearing screening) is
reported when a specific disorder cannot be identified or
when the follow-up hearing screening findings are normal.
You can also report Z01.118 (encounter for exam of ears
and hearing with other abnormal findings) and include the
code for the abnormal findings (eg, R94.120 [abnormal
auditory function study]).
15
❖❖ Clinical staff (eg, registered nurse) typically administers
and scores the completed instrument, while the physician
incorporates the interpretation component into the
accompanying E/M service.
❖❖ When a standardized screening or assessment is administered
along with any E/M service (eg, preventive medicine
service), both services should be reported, and modifier 25
(significant, separately identifiable E/M service by the same
physician on the same day of the procedure or other service)
may need to be appended to the E/M code to show the E/M
service was distinct and necessary at the same visit.
❖❖ Examples of both 96110 and 96127 instruments can be
found online at https://www.aap.org/en-us/professional
-resources/practice-transformation/getting-paid/Coding
-at-the-AAP/Pages/Private/Developmental-Screening-and
-Testing.aspx.
Immunizations
IMMUNIZATION ADMINISTRATION
Pediatric Immunization Administration Codes
16
❖❖ Component refers to all antigens in a vaccine that prevent
diseases caused by 1 organism. Multivalent antigens or multiple
serotypes of antigens against a single organism are considered
a single component of vaccines. Combination vaccines are
vaccines that contain multiple vaccine components. Conjugates
or adjuvants contained in vaccines are not considered to be
component parts of the vaccine, as defined previously.
❖❖ A qualified health care professional is an individual who by
education, training, licensure/regulation, facility credentialing
(when applicable), and payer policy is able to perform
a professional service within his or her scope of practice
and to independently report a professional service. These
professionals are distinct from clinical staff. A clinical staff
member is a person who works under the supervision of a
physician or other qualified health care professional and who is
allowed by law, regulation, facility, and payer policy to perform
or assist in the performance of specified professional services
but does not individually report any professional services.
❖❖ Code 90460 is used to report the first or only component in
a single vaccine given during an encounter. You can report
90460 more than once during a single office encounter.
Code 90461 is considered an add-on code to 90460
(hence the + symbol next to it). This means that the
provider will use 90461 in addition to 90460 if more
than 1 component is contained within a single vaccine
administered. The CPT ® codes 90460 and 90461 are
reported regardless of route of administration.
❖❖ Pediatric immunization administration (IA) codes (90460–
90461) are reported only when both of the following
requirements are met:
17
1. The patient must be 18 years or younger.
2. The physician or other qualified health care
professional must perform face-to-face vaccine
counseling associated with the administration.
18
Use 90474 in conjunction with 90460, 90471, or
90473.
❖❖ Codes 90471 and 90473 are used to code for the first
immunization given during a single office visit. Codes 90472
and 90474 are considered add-on codes (hence the + symbol
next to them) to 90460, 90471, and 90473. This means that
the provider will use 90472 or 90474 in addition to 90460,
90471, or 90473 if more than 1 vaccine is administered during
a visit. There can be only 1 first administration during a given
visit. (See vignettes 3, 4, and 5 on pages 23–26.)
❖❖ If during a single encounter for a patient 18 years or
younger, a physician or other qualified health care
professional only counsels on some of the vaccines, report
code 90460 (and 90461 when applicable) for those
counseled on and defer to codes 90472 or 90474, as
appropriate, for those that are not counseled on.
❖❖ The following vignettes may help illustrate the correct use of
the administration codes:
Vignette 1
A 5-year-old established patient is at a physician’s office for
her annual well-child examination. The patient is scheduled to
receive her first hepatitis A vaccine; her fifth diphtheria, tetanus,
and acellular pertussis (DTaP) vaccine; and the influenza
vaccine. After distributing the Vaccine Information Statements
and discussing the risks and benefits of immunizations with her
parents, the physician administers the vaccines.
19
How are the appropriate codes for this service selected?
Step 1: Select appropriate E/M code.
99393 Preventive medicine service, established patient,
age 5 to 11 years
20
+90461 each additional vaccine or toxoid component
administered (List separately in addition to code
for primary procedure.)
Step 4: Select the appropriate ICD-10-CM diagnosis
codes.
Diagnosis codes are used along with CPT ® codes to reflect the
outcome of a visit. The CPT codes tell a carrier what was done,
and ICD-10-CM codes tell a carrier why it was done.
The vaccine product CPT code and its corresponding IA
CPT code are always linked to the same ICD-10-CM code.
This is because the vaccine product and work that goes into
administering that product are intended to provide prophylactic
vaccination against a certain type of disease.
The ICD-10-CM lists only a single code to describe an encounter
in which a patient receives a vaccine. The code is Z23, and it
is reported at any encounter when a vaccine is given, including
routine well-child or adult exams.
The diagnosis codes for the 3 vaccines and 3 IA codes used in
this vignette are as follows:
21
Alternative Coding
CPT ® Codes ICD-10-CM Codes
99393 25 Preventive medicine service, established patient, 5–11 years Z00.129
90633 Hepatitis A vaccine product Z23
90700 DTaP vaccine product Z23
90686 Influenza virus vaccine, quadrivalent, preservative free, Z23
0.5 mL dosage
90460 (×3) Pediatric IA (hepatitis A, DTaP, influenza vaccines), Z23
first component
90461 (×2) Pediatric IA (DTaP vaccine), second and third components Z23
Rationale
Because the patient is younger than 18 years and there is
physician counseling, pediatric IA codes are reported (90460
and 90461). Each vaccine administered will be reported with its
own 90460 (hepatitis A, DTaP, and influenza). The only vaccine
with multiple components is DTaP. Because the first component
(ie, diphtheria) was counted in 90460, only the second and
third components (tetanus and acellular pertussis) are reported
with 90461 with 2 units.
Vignette 2
A 2-month-old established patient presents for her checkup. The
following vaccines are ordered: DTaP-Haemophilus influenzae
type b-inactivated poliovirus (Pentacel), pneumococcal, and
rotavirus. The physician counsels the parents on all of them, and
the nurse administers them all.
22
CPT ® Codes ICD-10-CM Codes
99391 25 Preventive medicine service, established patient, <1 year Z00.129
90698 DTaP-Hib-IPV (Pentacel) product Z23
90670 Pneumococcal product Z23
90680 Rotavirus vaccine, oral use Z23
90460 (×3) Pediatric IA (Pentacel, pneumococcal, rotavirus), first Z23
component
90461 (×4) Pediatric IA (Pentacel), each additional component Z23
Rationale
Because the patient is younger than 18 years and there is
physician counseling, pediatric IA codes are reported (90460,
90461). Clinical staff may administer the vaccine. Even though
an oral vaccine is administered, 90460 is still reported because
the code descriptor reads any route.
Vignette 3
A 19-year-old patient presents to the office to complete a
college physical examination (in college the patient will be living
in a dormitory). He is due for a tetanus-diphtheria-acellular
pertussis (Tdap) booster, meningococcal vaccine, and intranasal
influenza vaccine. The physician counsels the patient on each,
and the nurse administers each.
23
Rationale
The patient is older than 18 years; therefore, despite physician
counseling, pediatric IA codes cannot be reported. Instead,
codes 90471–90474 must be used.
Vignette 4
A 17-year-old patient presents to the office for her annual
checkup and to complete a college physical examination (in
college the patient will be living in a dormitory). The patient is
healthy and due for a Tdap booster, meningococcal vaccine, first
human papillomavirus (HPV, 9-valent) vaccine, and influenza
vaccine. The physician counsels the patient only on the
meningococcal and HPV vaccines, and the nurse administers
each. The patient is asked to return in 4 to 6 weeks for her
second HPV vaccine.
Rationale
Because the physician documents counseling only for the
meningococcal and HPV vaccines, code 90460 can be reported
only for those vaccines because the patient meets the age
criteria. For the Tdap and influenza vaccines, defer to non-
pediatric IA codes (90471–90472). In this case, however, a
24
first vaccine code is already reported with code 90460, so the
additional IA code 90472 has to be reported. While ICD-10-CM
does not provide official ages for the “adult” ICD-10-CM codes
(Z00.00 and Z00.01) in lieu of the well-child examination
codes, many payers use age 17 years as the cutoff. Refer to
specific payer policy for details.
Vignette 5
A 6-month-old patient presents to the office for her routine
checkup and to receive vaccines. The patient is due for DTaP,
pneumococcal, and hepatitis B vaccines. During the examination,
the physician finds an upper respiratory infection and fever.
The physician counsels the parent on the vaccines but decides
to defer for 2 weeks. The physician completes the well-baby
checkup on that day.
Two weeks later, the patient returns. The patient is afebrile
and asymptomatic and is seen only by the nurse. The DTaP,
pneumococcal, and hepatitis B vaccines are administered.
25
Rationale
If counseling occurs outside the IA service, there is no way to
report it separately. Therefore, in this vignette, there is nothing
separate to report during the well-child visit, and when the
patient returns and sees only the nurse, pediatric IA codes
cannot be reported; defer to codes 90471–90474. During the
preventive medicine service, when an acute illness is detected,
a code from 99212–99215 can be reported if the service is
significant and separately identifiable. Code 9921x is reported
with modifier 25. When the patient returns only for vaccines,
an E/M service is not reported. The ICD-10-CM code will be
reported for with abnormal findings (Z00.121) because an
abnormality was identified during the encounter.
For more information on IA codes, refer to the Coding at the
AAP Web site (www.aap.org/coding) and its page dedicated to
vaccine coding.
26
Vaccination not carried out due to
Z28.01 Acute illness
Z28.02 Chronic illness or condition
Z28.03 Immunocompromised state
Z28.04 Allergy to vaccine or component
Z28.1 Religious reasons
Z28.20 Unspecified reason
Z28.21 Patient refusal
Z28.81 Patient has disease being vaccinated against
Z28.82 Caregiver refusal
Z28.89 Other reason
Vignette
A 1-year-old presents for his routine well-child examination.
He is scheduled to receive his first measles, mumps, rubella;
hepatitis A; and varicella vaccines. Because he had a documented
case of varicella when he was 9 months of age, the varicella
vaccine is not given.
Report the following ICD-10-CM codes linked to the E/M service:
Z23 Encounter for immunization
Z28.81 Vaccination not carried out due to patient had disease
being vaccinated against
90702 Diphtheria and tetanus toxoids (DT), adsorbed when SP Diphtheria and 2
administered to younger than seven years, for IM use Tetanus Toxoids
Adsorbed
90700 Diphtheria, tetanus toxoids, and acellular pertussis vaccine SP DAPTACEL 3
(DTaP), when administered to <7 years, for IM usea GSK INFANRIX
90696 Diphtheria, tetanus toxoids, and acellular pertussis vaccine GSK KINRIX 4
and inactivated poliovirus vaccine (DTaP-IPV), when SP Quadracel
administered to children 4-6 years of age, for IM use
90723 Diphtheria, tetanus toxoids, acellular pertussis vaccine, GSK PEDIARIX 5
Hepatitis B, and inactivated poliovirus vaccine
(DTaP-Hep B-IPV), for IM use
90698 Diphtheria, tetanus toxoids, acellular pertussis vaccine, SP Pentacel 5
haemophilus influenza Type B, and inactivated poliovirus
vaccine (DTaP-IPV/Hib), for IM use
90633 Hepatitis A vaccine (Hep A), pediatric/adolescent dosage, GSK HAVRIX 1
2 dose, for IM use Merck VAQTA
90740 Hepatitis B vaccine (Hep B), dialysis or immunosuppressed Merck RECOMBIVAX HB 1
patient dosage, 3 dose, for IM use
90743 Hepatitis B vaccine (Hep B), adolescent, 2 dose, for IM use Merck RECOMBIVAX HB 1
90744 Hepatitis B vaccine (Hep B), pediatric/adolescent dosage, Merck RECOMBIVAX HB 1
3 dose, for IM use GSK ENERGIX-B
90746 Hepatitis B vaccine (Hep B), adult dosage, for IM use Merck RECOMBIVAX HB 1
GSK ENERGIX-B
90747 Hepatitis B vaccine (Hep B), dialysis or immunosuppressed GSK ENERGIX-B 1
patient dosage, 4 dose, for IM use
90748 Hepatitis B and Hib (Hep B-Hib), for IM use Merck COMVAX 2
90647 Hemophilus influenza B vaccine (Hib), PRP-OMP conjugate, Merck PedvaxHIB 1
3 dose, for IM use
90648 Hemophilus influenza B vaccine (Hib), PRP-T conjugate, SP ActHIB 1
4 dose, for IM use GSK HIBERIX
90651 Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, Merck GARDASIL 9 1
52, 58, nonavalent (HPV), 2 or 3 dose schedule, for IM use
90630 Influenza virus vaccine, quad (IIV4), split virus, preservative SP Fluzone 1
free, for intradermal use Intradermal Quad
90672 Influenza virus vaccine, quad (LAIV), live, intranasal use MedImmune Flumist Quad 1
90674 Influenza virus vaccine, quad (ccIIV4), derived from cell Seqirus Flucelvax 1
cultures, subunit, preservative and antibiotic free, 0.5 mL
dosage, IM (Do not use for multi-dose – report 90749)
(continued on next page)
28
(continued from previous page)
No. of
Product Separately report the administration with codes Vaccine
Code 90460–90461 or 90471–90474. Manufacturer Brand Components
90682 Influenza virus vaccine, quad (RIV4), derived from Protein Flublok 1
recombinant DNA, HA protein only, preservative and antibiotic Sciences
free, IM use
90685 Influenza virus vaccine, quad (IIV4), split virus, preservative SP Fluzone Quad 1
free, 0.25ml dose, for IM use
90686 Influenza virus vaccine, quad (IIV4), split virus, preservative Seqirus Afluria 1
free, 0.5ml dosage, for IM use SP FLUARIX Quad
GSK Fluzone Quad
GSK FLULAVAL
90687 Influenza virus vaccine, quad (IIV4), split virus, 0.25ml dosage, SP Fluzone Quad 1
for IM use
90688 Influenza virus vaccine, quad (IIV4), split virus, 0.5ml dosage, SP Fluzone Quad 1
for IM use GSK FLULAVAL
90756 or Influenza virus vaccine, quad(ccIIV4), derived from cell cultures, Seqirus Flucelvax Quad 1
90749 subunit, antibiotic free, 0.5mL dosage, for IM use
90656 Influenza virus vaccine, tri (IIV3), split virus, preservative Seqirus AFLURIA 1
free, 0.5ml dosage, for IM use Novatis Fluvirin
90658 Influenza virus vaccine, tri (IIV3), split virus, 0.5ml dosage, for Seqirus AFLURIA 1
IM use Novartis Fluvirin
90673 Influenza virus vaccine, tri (RIV3), derived from recombinant Protein Flublok 1
DNA, HA protein only, preservative and antibiotic free, IM use Sciences
90707 Measles, mumps, and rubella virus vaccine (MMR), live, for Merck M-M-R II 3
subcutaneous use
90710 Measles, mumps, rubella, and varicella vaccine (MMRV), live, Merck ProQuad 4
for subcutaneous use
90620 Meningococcal recombinant protein and outer membrane Novartis Bexsero 1
vesicle vaccine, serogroup B (MenB-4C), 2 dose schedule,
for IM use
90621 Meningococcal recombinant lipoprotein vaccine, serogroup B, Pfizer Trumenba 1
2 or 3 dose schedule, for IM use
90644 Meningococcal conjugate vaccine, serogroups C & Y and GSK MenHibrix 2
Hemophilus influenza B vaccine (MenCY-Hib), 4-dose
schedule, (children 6 weeks-18 months of age), for IM use
90733 Meningococcal polysaccharide vaccine, serogroups A, C, Y, SP Menomune 1
W-135, quad (MenACWY or MPSV4), for subcutaneous use
90734 Meningococcal conjugate vaccine, serogroups A, C, Y and SP Menactra 1
W-135 quad (MenACWY or MCV4) , for IM use Novartis Menveo
90670 Pneumococcal conjugate vaccine, 13 valent (PCV13), for IM use Pfizer PREVNAR 13
90732 Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), Merck PNEUMOVAX 23 1
adult or immunosuppressed patient dosage, when
administered to 2 years or older, for subcutaneous or IM use
90713 Poliovirus vaccine (IPV), inactivated, for subcutaneous or SP IPOL 1
IMuse
90680 Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, live, Merck RotaTeq 1
for oral use
(continued on next page)
29
(continued from previous page)
No. of
Product Separately report the administration with codes Vaccine
Code 90460–90461 or 90471–90474. Manufacturer Brand Components
Laboratory
Two different practice models surround the conducting of
laboratory tests: blood is drawn in office and specimen is sent
to an outside laboratory for analysis, or blood is drawn and
laboratory tests are performed in the physician’s practice. Never
report the laboratory code for a laboratory test that the practice
does not run in-house or is not financially responsible for and
billed by the outside laboratory. In those cases, report only the
blood draw and specimen handling, as appropriate.
30
MODEL 1: BLOOD IS DRAWN IN OFFICE
AND SPECIMEN IS SENT TO AN OUTSIDE
LABORATORY FOR ANALYSIS.
CPT ® Code
31
36410 Venipuncture, 3 years or older, necessitating
physician’s skill, for diagnostic or therapeutic purposes
(not be used for routine venipuncture)
36415 Collection of venous blood by venipuncture
36416 Collection of capillary blood specimen (eg, finger,
heel, ear stick)
Venipuncture ICD-10-CM Codes
32
Anemia Screening ICD-10-CM Code
83655 Lead
Lead Screening ICD-10-CM Code
NOTE: Only report the S3620 if you are billing for the actual
running of the lab or test kit. Otherwise only report the
appropriate blood collection code (eg, 36416)
33
Z13.0 Encounter for screening for diseases of the blood and
blood-forming organs and certain disorders involving
the immune mechanism (eg, anemia, sickle cell)
Z13.21 Encounter for screening for nutritional disorder
Z13.228 Encounter for screening for other metabolic disorders
(eg, PKU, galactosemia)
Z13.29 Encounter for screening for other suspected
endocrine disorder (eg, thyroid)
34
Z12.89 Encounter for screening for malignant neoplasms of
other sites
Tuberculosis Testing (Mantoux/Purified Protein
Derivative [PPD])
35
87591 Infectious agent detection by nucleic acid (DNA or
RNA); N gonorrhoeae, amplified probe technique
87810 Infectious agent detection by immunoassay with
direct optical observation; C trachomatis
87850 Infectious agent detection by immunoassay with
direct optical observation; N gonorrhoeae
36
❖❖ Examples of HCPCS Level II codes relevant to pediatric
preventive care include
S0302 Completed Early and Periodic Screening, Diagnosis,
and Treatment service (List in addition to code for
appropriate E/M service.)
S0610 Annual gynecologic examination; new patient
S0612 Annual gynecologic examination; established patient
S0613 Annual gynecologic examination, clinical breast
examination without pelvic examination
S0622 Routine examination for college, new or established
patient (List separately in addition to appropriate
E/M code.)
S9444 Parenting classes, nonphysician provider, per session
S9445 Patient education, not otherwise classified,
nonphysician provider, individual, per session
S9446 Patient education, not otherwise classified,
nonphysician provider, group, per session
S9447 Infant safety (including cardiopulmonary resuscitation)
classes, nonphysician provider, per session
S9451 Exercise classes, nonphysician provider, per session
S9452 Nutrition classes, nonphysician provider, per session
S9454 Stress management classes, nonphysician provider,
per session
37
Commonly Reported ICD-10-CM Codes for
Preventive Services
ICD-10-CM
Code Descriptor Special Coding Conventions
Encounter and Examination Codes
Z00.110 Newborn check under 8 days old Outpatient codes only
Z00.111 Newborn check 8 to 28 days old Outpatient codes only
Z00.121 Routine child health examination with First-listed ICD-10-CM code only.
abnormal findings Includes routine screening when
Z00.129 without abnormal findings performed at same encounter.
Z00.00 General adult medical examination First-listed ICD-10-CM code only.
without abnormal findings Typically used for patients 18 years and
Z00.01 with abnormal findings older (payer policy).
Z02.0 Examination for admission to Not required in addition to a Z00 code
educational institution
Z02.4 Examination for driving license
Z02.5 Examination for participation in sport
Z01.00 Examination of eyes and vision without First-listed ICD-10-CM code only. Do not
abnormal findings report as a secondary code or in addition
Z01.01 with abnormal findings to a Z00 code.
Z01.110 Hearing examination following failed First-listed ICD-10-CM code only. Do not
hearing screening report as a secondary code or in addition
to a Z00 code.
Z01.10 Encounter for examination of ears and First-listed ICD-10-CM code only. Do not
hearing without abnormal findings report as a secondary code or in addition
Z01.118 with other abnormal findings to a Z00 code.
Z23 Immunizations This is the only code in ICD-10-CM for
vaccines. Link to both the product and
administration CPT ® codes.
Z29.3 Encounter for prophylactic fluoride
administration
Screening Codes
Z11.1 Respiratory tuberculosis A screening code is not necessary
if the screening is inherent to a routine
examination. But can be reported.
Z11.3 Infections with a predominantly sexual A screening code is not necessary
mode of transmission (excludes HPV if the screening is inherent to a routine
and HIV) examination. But can be reported.
Z12.4 Encounter for screening for malignant A screening code is not necessary
neoplasm of cervix (excludes HPV) if the screening is inherent to a routine
examination. But can be reported.
Z12.79 Malignant neoplasm of other genitourinary A screening code is not necessary
organs if the screening is inherent to a routine
Z12.89 Malignant neoplasms of other sites examination. But can be reported.
Z13.29 Other suspected endocrine disorder A screening code is not necessary
if the screening is inherent to a routine
examination. But can be reported.
Z13.1 Diabetes mellitus A screening code is not necessary
if the screening is inherent to a routine
examination. But can be reported.
(continued on next page)
38
(continued from previous page)
ICD-10-CM
Code Descriptor Special Coding Conventions
Screening Codes
Z13.228 Other metabolic disorders (eg, inborn A screening code is not necessary
errors of metabolism, galactosemia, if the screening is inherent to a routine
PKU) examination. But can be reported.
Z13.220 Lipid disorders A screening code is not necessary
if the screening is inherent to a routine
examination. But can be reported.
Z13.21 Nutritional disorder A screening code is not necessary
Z13.228 Other metabolic disorder if the screening is inherent to a routine
Z13.29 Other suspected endocrine disorder examination. But can be reported.
Z13.0 Diseases of the blood and blood-forming A screening code is not necessary
organs and certain disorders involving if the screening is inherent to a routine
the immune mechanism (eg, anemia, examination. But can be reported.
sickle cell)
Z13.89 Other disorders (eg, depression) A screening code is not necessary
if the screening is inherent to a routine
examination. But can be reported.
Z13.4 Developmental disorders in childhood Do not report in addition to a
(excludes routine screening) (eg, autism) Z00.12- code; it is already included.
Z13.88 Disorder due to exposure to A screening code is not necessary
contaminants (eg, lead) if the screening is inherent to a routine
examination. But can be reported.
Performance Measure Codes
Z68.51 Body mass index (BMI) pediatric,
< 5th percentile for age
Z68.52 Body mass index (BMI) pediatric, 5th
percentile to < 85th percentile for age
Z68.53 Body mass index (BMI) pediatric, 85th
percentile to < 95th percentile for age
Z68.54 Body mass index (BMI) pediatric,
≥ 95th percentile for age
Z71.3 Dietary counseling and surveillance
Z71.82 Exercise counseling
Underimmunized Status and Vaccines Not Given
Z28.3 Underimmunized status A status code is informative and may
affect the course of treatment and its
outcome. Report when this is the case.
Z28.01 Vaccine not given: Acute illness
Z28.04 Allergy to vaccine or components
Z28.82 Caregiver refusal
Z28.02 Chronic illness or condition
Z28.03 Immune compromised state
Z28.21 Patient refusal
Z28.81 Pt had disease being vaccinated for
Z28.1 Religious reasons
Z28.89 Other reason
Z28.20 Unspecified reason
39
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